Provider Demographics
NPI:1538150925
Name:WEKULLO, VERRA L (MD)
Entity type:Individual
Prefix:
First Name:VERRA
Middle Name:L
Last Name:WEKULLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19550 E 39TH ST S
Mailing Address - Street 2:SUITE 105-B
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64057-2303
Mailing Address - Country:US
Mailing Address - Phone:816-254-2552
Mailing Address - Fax:816-833-4155
Practice Address - Street 1:19550 E 39TH ST S
Practice Address - Street 2:SUITE 105 - B
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057-2303
Practice Address - Country:US
Practice Address - Phone:816-254-2552
Practice Address - Fax:816-833-4155
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005028572207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200277705Medicaid
KS200363160AMedicaid
MO200277705Medicaid
KS200363160AMedicaid